The ‘G20 Bali Leaders’ Declaration’ from November 2022 covers matters related to health and reaffirms the commitment to strengthening health systems. It emphasizes the need for equitable access to pandemic medical countermeasures, reaffirms their commitment to strengthen global health governance with the leading and coordination role of WHO with support from other international organizations, and supports the work of an intergovernmental negotiating body that will draft and negotiate legally binding instrument and the working group on the international health regulations (IHR).

While the declaration welcomes the establishment of a new Financial Intermediate Fund (FIF) for pandemic prevention, preparedness, and response (PPR) – ‘the Pandemic Fund’, pledges by donors amounted to only USD 1.4 billion against an estimated annual PPR financing gap of USD 10 billion. The declaration alludes to equitable access to vaccines, diagnostics, and therapeutics. There is a commitment to the One Health approach and enhancing global surveillance, including genomic surveillance to detect pathogens and antimicrobial resistance (AMR) that may threaten human health.

The declaration recognizes the need for strengthening local and regional global health products research, development, and manufacturing capacities. However, the sharing and transfer of knowledge and technology are made contingent on voluntary and mutually agreed terms. It expresses support for international dialogue and collaboration on the establishment of trusted global digital health networks. The declaration elaborates on other areas (economy, environment, conflicts, migrants, equity, digital inclusivity, etc.,) that have either a direct or indirect impact on the health of people.

While the intent on several issues is in the right direction, the declaration falls short on specifics. Can the Indian presidency nudge G20 towards actionable global health policies? The world has realized that the world is one, all beings are a family, we are interconnected and interdependent and our future is tied to each other. This year’s theme, based on the ancient Upanishadic wisdom stated in ‘Vasudhaiva Kutumbakam’ (‘vasudha’= the world; ‘eva’= is thus; ‘kutumbakam’= family) engraved in the entrance hall of the Parliament of India, reflects the above reality. 

There is a consensus amongst nations on strengthening WHO and bringing about a participatory governance structure that engages various other actors of the global health ecosystem for better coordination and collaboration. India can articulate a new framework for revamped governance architecture that takes into consideration the equity and inclusivity of all member nations and also the collaborative engagement of non-state actors. The process to strengthen existing binding and non-binding international health regulations has already begun by the World Health Assembly. Global Health Intelligence based on robust digital and genomic surveillance and an agreed mechanism of information sharing while ensuring data privacy and security is essential for preventing future pandemics.

The pandemic fund is a welcome development to address the financial needs of low- and middle-income member nations to strengthen their public health systems as part of pandemic prevention preparedness and response. The same concept of pooling, prioritizing, and allocating adopted for financial resources can be applied to essential health goods to prevent future pandemics and respond to them when needed. These include human resources, vaccines, diagnostics, and drugs. The global fund, GAVI, ACT, and CEPI have demonstrated the power of pooling resources from multiple actors. G20 should deliberate on global health policies and strategies to prevent supply-chain disruptions from being witnessed on account of lockdowns and conflicts. A fine balance needs to be established between the merits and demerits of localization versus globalization. Regional clusters may be a way out of the dilemma.

Digital information and communication technologies have demonstrated the power to integrate the world and transform various sectors. However, there is a risk of introducing another social divide between those who have access and those who do not have access to digital technologies. Similarly, not all countries have the needed digital infrastructure. There is a risk of many health systems being left behind on account of the potential risk of the digital divide. India is best positioned to initiate the dialogue around digital public health goods to overcome the threat of the digital divide.

While climate change, food, and energy security have overtaken health as priority agenda, India should take the health agenda to its logical end of ‘Health for All’. Krishna Reddy Nallamalla   

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